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Question 30: It is not uncommon for TS children (even adults) to be sexually inappropriate, perhaps intrusive and not complying with the cultural/societal norms. How does one address this in an in-service since the question has popped up? More importantly, how does one handle this behaviour to extinguish it? With some young children it seems to extinguish fairly quickly with talking and substitution training for in public. For others whom are at the age when this can be viewed as deviant, criminal behaviour--Young Offenders 12+ and age of sexual consent 14 years--what suggestions for working with these young people. Some of them are hypersexual....so some management issues need to be addressed. K.T., BC, Canada.

Hi K.T.!

I would approach 'sexual inappropriateness (in terms of tics, impulsive acts/words, etc.) by first recognizing that the only difference between this tic/compulsive behaviour/impulse and any other is the difference it holds in cultural meaning/interpretation/importance to others. Teachers and staff need to be assured that this behaviour is simply another, albeit unfortunate, symptom -- not anyore indicative of sexual abuse or sexual morals than any other tic is.

I think it's also important to emphasize the 'rules' of tics again at a time like this -- the bigger a deal that is made of a tic, the more apt that tic will increase in frequency and/or intensity (i.e. attention, concentration, and stress surrounding that behaviour will paradoxically fuel that very behaviour). From this perspective, it is often the individual who would be MOST mortified by engaging in these sorts of behaviours (say, the son of a minister) who gets caught up in them. It is also important to again emphasize how tics are a form of disinhibition -- a loss of censors. Everyone -- particularly in puberty -- thinks a lot about sex and is devoting a disproportionate amount of energy to sexuality (in terms of attention, curiousity, physical maturation, etc.) at this point in life. It is of little surprise then that in a person without good brakes might wear some of this interest 'on his sleeves' so to speak. Framing it in this way helps increase empathy for the person's 'rape of privacy' -- most have the luxury (and dignity) of learning to cope with this new facet of normal human development with more discretion.

In terms of dealing with the symptoms, again because they are no different (neurologically) than any other TS symptoms I don't have 'special' strategies to offer. Habit-reversal training (a component of the Comprehensive Behavioural Intervention for Tics or CBIT as outlined in my book) is an option, as is symptom negotiation (touching oneself, for example, from inside a pocket rather than more explicitly), education of the environment (peers, teachers, etc.).

In terms of hypersexuality, I agree that this is an often undiscussed issue that needs to be brought out for discussion more. I have been working on a hypersexuality article for an upcoming Disinhibited Thoughts -- stayed tuned!! :-)

Hope this helps!
Dr. Dunc.

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